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PubMed1976

Simultaneous subdural effusion and hydrocephalus in infancy.

Hydrocephalus and subdural hematoma or effusion of infancy rarely present simultaneously, where both are active contributors to acutely increased intracranial pressure. In three cases, clinical findings characteristic of both were present. Decompression of one can facilitate expansion of the other. Rapid progression of unsuspected hydrocephalus could be responsible for some of the poor results reported after treatment of subdural effusion alone. This possibility should be considered whenever progress is unsatisfactory during treatment of subdural effusion.

Brain↗
PubMed1975

[Traumatic aneurysm of the frontopolar artery developing after evacuation of the subdural effusion in a 6-month-old girl (author's transl)].

A 6-month-old girl developed bilateal subdural effusion after head injury. She gradually improved after the partial stripping of the membrane of the subdural effusion although postoperative tappings of the subdural fluid were necessary. Thirty nine days after the injury, she suddenly suffered from a massive intraventricular hemorrhage. A cerebral angiography showed an aneurysm arising from the proximal part of the right frontopolar artery, which had not been revealed in the previous angiograms. It was obscure whether the congenital anomaly of the arterial wall had been existed or not, but this aneurysm might be mentioned as a traumatic aneurysm and definitely developed after the treatment for the traumatic sequence. The mechanism of this aneurysmal formation was supposed that the arterial wall was initially injured by the abnormal traumatic movement of the brain underneath the falx cerebri, and teared arterial wall was further injured by the fluctuating movements of the brain caused by repeated tappings of the effused fluid. Relation of delayed posttraumatic apoplexy and ruptured posttraumatic aneurysms was also discussed, and analysis of the reported cases of the traumatic aneurysm, as well as aneurysm in the infant, was made.

Cerebral Hemorrhage↗
PubMed1991

Acute aggravation of subdural effusion associated with pachymeningitis carcinomatosa: case report.

The authors present a case of acute aggravation of subdural effusion associated with pachymeningitis carcinomatosa. Microscopic examination of a surgical specimen revealed diffuse involvement of the dura mater by a metastatic adenocarcinoma in which the tumor cells invaded venules located in the areolar layer in particular. The rapid increase in capillary transmural pressure resulted in extravasation of plasma components, causing an increase in subdural effusion.

Adenocarcinoma↗
PubMed1999

Treatment of a symptomatic posterior fossa subdural effusion in a child.

We describe the first observation of a child with a posterior fossa subdural effusion with secondary hydrocephalus and tonsillar herniation. We diagnosed this entity in a 14-month-old girl with no history of trauma or coagulation disorder. The patient presented in our emergency department with opisthotonus and raised intracranial pressure resulting from supratentorial hydrocephalus. An emergency ventriculo-peritoneal shunt was placed, which resolved the symptoms only temporarily. Eventually external drainage of the subdural fluid was performed. The collection gradually disappeared, and both the external subdural shunt and the ventriculo-peritoneal shunt were removed. The patient made a complete neurological recovery. We review the physiopathology and treatment of subdural effusions in general, and propose some guidelines for the management of symptomatic effusions occurring in the posterior fossa in particular.

Cranial Fossa, Posterior↗
PubMed2003

[A spontaneous bilateral subdural effusion in an 11-year-old boy with middle cranial fossa arachnoid cyst].

An 11-year-old boy gradually developed headache, vomiting and diplopia over a period of 1 month. Repeated examinations of head CT scan revealed an arachnoid cyst in the right middle cranial fossa and bilateral subdural effusion of enlarging size. Papilledema was absent on admission, but it became evident after 1 week, and lumbar puncture disclosed very high pressure (800 mmH2O) of the cerebrospinal fluid. Fenestration of the cyst to the basal cisterms quickly alleviated his symptoms of intracranial hypertension as well as the bilateral subdural effusion on CT. Macroscopically, there was a small tear on the wall of the arachnoid cyst, and it probably served as a communication valve with the subdural space. Since he had no history of head trauma in the past few months, the reason of the tear formation was unclear. Intracranial arachnoid cyst is a relatively common congenital malformation of usually benign and non-pathogenic nature. However, it may occasionally cause non-traumatic subdural effusion and intracranial hypertension.

Arachnoid Cysts↗
PubMed1970

[Clinical and electroencephalographic findings in subdural effusions (report of 17 cases)].

The author gives an account of 17 children aged 1 month to 1;1 years, in whom uni- or bilateral subdural effusions had occurred. Etiologically, toxicoses due to infantile enteritides were made responsible in 5 cases, pneumococcic meningitides in 3 cases, and encephalitides in 3 cases. For 6 children it was not possible to obtain clear etiological results. It is emphasized that subdural effusions subsequent to toxicoses are perhaps a more frequent occurrence than has been believed heretofore. The clinical symptomatology of subdural fluid accumulations, which is described in the literature, failed to be observed in nearly all cases. E. E. G. derivations were particularly indicated under such diagnoses as propulsive petit mal and grand mal epilepsies. Electroencephalographically, the leading characteristic symptom in 13 cases was a uni- or bilateral reduction of potentials. The derivation thus provided for an almost pathognomonic interpretation. However, by reference to the electroencephalograms of 4 other children it is possible to demonstrate that, in agreement with the information and data given in the literature, it is not possible to obtain any reliable indications of subdural accumulations of fluid. Therefore, in case of doubt one should not dispense with a test puncture of the fontanel even in case of nonspecific E. E. G. variations.

Dominance, Cerebral↗
PubMed2002

Bilateral subdural effusion and cerebral displacement associated with spontaneous intracranial hypotension: diagnostic and management strategies. Report of two cases.

The authors describe two patients with bilateral subdural effusion and cerebral displacement associated with spontaneous intracranial hypotension (SIH) and discuss the possible pathophysiological origins of these abnormalities. The signs seen on magnetic resonance imaging in both cases, such as tonsillar descent, subdural effusion, meningeal enhancement, downward displacement of the optic chiasm, and crowding of this structure and the hypothalamus between the pituitary gland and brain, can help to establish the diagnosis of SIH. Therapy with a lumbar epidural blood patch resulted in the rapid resolution of all symptoms and most morphological abnormalities. The authors propose diagnostic and management strategies based on their own experiences and the reported cases of SIH in the medical literature.

Algorithms↗
PubMedDate not supplied

Bilateral subdural effusions related to disease activity in familial hemophagocytic lymphohistiocytosis in an 8-month-old infant.

An 8-month-old girl had classic features of hemophagocytic lymphohistiocytosis (HLH). A presumptive diagnosis of familial hemophagocytic lymphohistiocytosis was made on the basis of her age and the presence of parental consanguinity. In view of abnormal neurologic findings at presentation, a magnetic resonance imaging scan was performed and showed bilateral proteinaceous subdural effusions. These resolved within 1 week of commencement of chemotherapy for the primary condition. These subdural effusions were the only objective documentations of central nervous system involvement, along with an increased cerebrospinal fluid protein level. We also report other radiologic findings of HLH, which are of use in strengthening this diagnosis in individuals in whom the diagnosis is strongly suspected.

Ascites↗
PubMed1990

Subdural effusion and its relationship with neurologic sequelae of bacterial meningitis in infancy: a prospective study.

One hundred thirteen infants, aged 1 to 18 months, were screened systematically and serially using transillumination for the presence of subdural effusion during acute bacterial meningitis due to Haemophilus influenzae type b, Streptococcus pneumoniae, or Neisseria meningitidis. Effusion developed in 44 (39%) of the patients during the course of treatment. Young age, rapid onset of illness, low peripheral white blood cell count, and high cerebrospinal fluid levels of protein and bacterial antigen were associated with a higher likelihood of developing effusion. Although patients with effusion were more likely to have neurologic abnormalities both at the time of admission and at completion of therapy, and were more likely to have seizures during the course of treatment, there was no greater incidence of seizures, hearing loss, neurologic deficits, or developmental delay on longterm follow-up (median follow-up interval 5.5 years) in patients with effusion. Specific invasive therapy is not indicated in infants with meningitis and subdural effusion who are otherwise improving.

Cerebrospinal Fluid Proteins↗
PubMedDate not supplied

[Empyema and subdural effusion after meningitis. 2 cases of unusual location].

A 12-year old child and a 2-month old infant developed, in the wane of a purulent meningitis, the former, an infratentorial subdural empyema, the latter, a large, encapsulated, haemoorhagic, aseptic subdural effusion, in the right parieto-temporo-occipital region. In both cases, signs of intracranial hypertension dominated the clinical picture. Neuroradiological investigations permitted diagnosis and localisation of the expansive processes, whose subdural position was recognized at operation and confirmed by histopathological examination. According to the literature, purulent meningitis is a rare cause of subdural empyema, except in infants; the solely infratentorial location is also unusual. Sterile subdural effusion is a more common complication of purulent meningitis in infancy, but the unilateral posterior supratentorial location is also a peculiar feature. Subdural collections after memingitis may be aseptic and possibly haemorrhagic, or septic and purulent; these different modes of presentation correspond perhaps to different degrees or stages of subdural pathological changes in the neighbourhood of leptomeningeal infection.

Brain Diseases↗
PubMed1983

Subdural effusions re-appearing after shunts in patients with non-tumoural stenosis of the aqueduct.

Three patients shunted for non-tumoural stenosis of the aqueduct suffered from progressive clinical symptoms about four months after the shunting. Computed tomography (CT) showed bilateral subdural effusions. The effusions were evacuated, and the shunts revised. One month later all patients suffered from symptoms of increased intracranial pressure, and CT showed enlargement of the supratentorial cerebral ventricles. The effusions had disappeared. After shunt revision the symptoms decreased again. The fluctuation in the ventricular size, the thickness of the subdural effusions, and the clinical deterioration were related to the change in the opening pressure of the shunt valve in all patients. Patients with large supratentorial cerebral ventricles (Evans index over 0.40) should be monitored by intraventricular pressure recording in order to select the exact opening pressure of the shunt valve before inserting a relieving shunt; a clinical check-up and a CT examination should be carried out about three months after the operation in order to investigate any changes in the function of the shunt.

Adult↗
PubMed1976

Surgical treatment of subdural effusions in infants.

We puropose a simplified method for external drainage of subdural effusions in infants, not calling for a second operation to remove the catheters. This method allows the daily control of evacuated fluid, guarantees smooth and uninterrupted drainage, and permits analysis of the subdural collection. This operation which we would like to call external controlled drainage, does not call for parenteral feeding, but demands paediatric and neurosurgical collaboration. The method has no pretensions other than being simple, easy, and safe.

Drainage↗
PubMed1982

Subdural effusion in the first six months of life.

During the period 1978-1981, among 1280 (0-12 months old) infants suffering from consequences of various pre- and perinatal cerebral lesions, positive neuroradiological changes were found in 148 cases. Of these, 56 proved to be real subdural effusions with elevated ICP and increased protein content. Periodical transfontanellar taps and drainage were effective in 49 cases. A neurosurgical operation was performed in 7 infants because of the poor effect of the above treatment. In these 7 infants the encapsulation process was nearly complete. Early chronic subdural effusion exerts a devastating influence on the maturing brain partly by the high ICP. Early treatment often cures the process and major surgery is not needed. Early neurorehabilitation and habilitation coordinated with elimination of the effusion is the method of choice. Prudence is recommended in selecting the appropriate cases for instrumental therapy because some small effusions and fluid accumulations may disappear by the end of the first year.

Drainage↗
PubMed2002

[Clinical characteristics of chronic subdural hematoma evolving from traumatic subdural effusion].

OBJECTIVE: To probe into the incidence, mechanism and clinical characteristics of chronic subdural hematoma (CSDH) evolving from traumatic subdural effusion (TSE). METHODS: The clinical materials of 32 patients with CSDH evolving from TSH were analyzed retrospectively and the correlative literature was reviewed. RESULTS: 16.7% of the patients with TSH evolved into CSDH. The time of evolution was 22 - 100 days after head injury. All patients were cured with hematoma drainage. CONCLUSIONS: TSE is one of the origins of CSDH. The clinical characteristics of TSE evolving into CSDH include polarization of patient age, and chronic small effusion. The patients are usually injured deceleratedly and accompanied with mild cerebral damage.

Adolescent↗
PubMed1978

[Pathogenesis of persistent subdural effusions in infants (author's transl)].

Current theories on the pathogenesis of persistent subdural effusions in infants are not supported by our clinical and operative data. In our more recent cases, a daily electrophoretic analysis of the fluid obtained by external subdural drainage has been performed and allowed to disclose the presence or progressive appearance of cerebro-spinal fluid. The relative concentrations, observed for some proteins present in the fluid collected in this way, cannot be explained by simple filtration, but enforces us to postulate the existence of a free communication between the subarachnoid and the subdural spaces. These first results support our initial hypothesis assuming that persistent effusions are supplied and even replaced by cerebro-spinal fluid, due to the occurrence of a communicating hydrocephalus ruptured in the subdural space. There is thus no sound physiopathological basis for treating these cases with membranectomy and we suggest instead that the treatment of choice should be a fluid derivation.

Brain Diseases↗
PubMed2005

Contralateral subdural effusion after aneurysm surgery and decompressive craniectomy: case report and review of the literature.

We report a complication of decompressive craniectomy in the treatment of aneurismal subarachnoid hemorrhage (SAH) and accompanying middle cerebral artery (MCA) infarction. A 56-year-old man presented with subarachnoid hemorrhage and right sylvian hematoma. He was diagnosed with high-grade SAH and medical therapy was employed. He showed rapid clinical deterioration on day 9 of his admission. Computed tomographic scans showed right MCA infarction and prominent midline shift. Because of the patient's rapidly worsening condition, further evaluation to find origin of SAH could not be obtained, and decompressive right hemicraniectomy was performed. During sylvian dissection, right middle cerebral and posterior communicant artery aneurysms were detected and clipped. One week after operation, a contralateral frontoparietal subdural effusion and left to right midline shift was detected and drained through a burr-hole. Through successive percutaneous aspirations, effusion recurred and complete resolution was achieved after cranioplasty and subduroperitoneal shunt procedures. Decompressive craniectomy is generally accepted as a technically simple operation with a low incidence of complications. In the light of this current case, we hypothesize that a large craniectomy may facilitate the accumulation of recurrent effusion on contralateral side creating a resistance gradient between two hemispheres. This point may be especially true for subarachnoid hemorrhage cases requiring aneurysm surgery. We conclusively suggest that subdural effusions may be resistant to simple drainage techniques if a large contralateral craniectomy does exist, and early cranioplasty may be required for treatment in addition to drainage procedures.

Craniotomy↗
PubMed1980

Leakage of contrast into a postmeningitic subdural effusion: a CT finding.

The CT findings in a 6-month-old boy with hemophilus influenzae meningitis, complicated by the occurrence of bilateral subdural effusions, are described. The effusions were hypodense and the contents markedly enhanced (increase of 40 Hounsfield units) after contrast injection.

Extravasation of Diagnostic and Therapeutic Materi↗